A Systematic Review of Paradoxical Adipose Hyperplasia (PAH) Post-Cryolipolysis

January 2017 | Volume 16 | Issue 1 | Original Article | 62 | Copyright © January 2017


Derek Ho BSa,b and Jared Jagdeo MD MSa,b,c

aSacramento VA Medical Center, Mather, CA bUniversity of California Davis, Sacramento, CA cState University of New York Downstate Medical Center, Brooklyn, NY

prior to treatment. Regular follow-up visits are important as patients may be self-conscious, however timely diagnosis and surgical management of PAH may yield excellent outcomes. Limitations of this systematic review include lack of published speci cations of applicator size and treatment settings regarding whether suction was applied. Faster (35 minutes), colder (-11°C) applicators and updated recommended treatment settings have been released that function with or without suction. Based upon the published literature, we believe that the current incidence of PAH may be higher than reported.This may be due to a combination of factors: PAH was previously underrecognized or underreported and cryolipolysis is among the fastest growing non-invasive body sculpting procedure employed today. Although the pathoetiology of PAH is currently unknown, we hypothesize that some adipocytes may be "naturally selected" for survival due to their inherent tolerance to cryolipolysis. We envision future studies may utilize molecular assays and genomic evaluations to characterize involvement of key pathways responsible for PAH. PAH is signi cant as cryolipolysis is becoming more widely available and performed by physicians and non-physician technicians in outpatient clinics, med spas, and aesthetic of faces. We believe that while cryolipolysis is an effective non-invasive treatment option for body contouring, physicians and patients should be aware of PAH as a potential adverse effect and treatment options.

DISCLOSURES

DH has no con icts of interest to disclose. Dr. Jagdeo is a sci- entific consultant for Zeltiq. The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.

REFERENCES

  1. American Society for Dermatologic Surgery. ASDS survey: Nearly 10 million treatments performed in 2015. https://www.asds.net/_Media.aspx?id=9449. Accessed June 14, 2016. 
  2. American Society for Dermatologic Surgery. ASDS survey: 52 percent of consumers considering cosmetic procedures. https://www.asds.net/con- sumersurvey/. Accessed June 14, 2016. 
  3. Munavalli GS, Panchaprateep R. Cryolipolysis for Targeted Fat Reduction and Improved Appearance of the Enlarged Male Breast. Dermatol Surg. 2015;41(9):1043-1051. 
  4. American Society for Aesthetic Plastic Surgery. Quick Facts: Highlights of the ASAPS 2015 Statistics on Cosmetic Surgery. http://www.surgery.org/ sites/default/ les/2015-quick-facts.pdf. Accessed June 14, 2016. 
  5. Jalian HR, Avram MM. Body Contouring: The Skinny on Noninvasive Fat Re- moval. Semin Cutan Med Surg. 2012;31(2):121-125. 
  6. Kennedy J, Verne S, Grif th R, Falto-Aizpurua L, Nouri K. Non-invasive subcutaneous fat reduction: A review. J Eur Acad Dermatol Venereol. 2015;29(9):1679-1688. 
  7. Manstein D, Laubach H, Watanabe K, et al. Selective cryolysis: A novel method of non-invasive fat removal. Lasers Surg Med. 2008;40(9):595-604. 
  8. Jalian HR, Avram MM. Cryolipolysis: A historical perspective and current clinical practice. Semin Cutan Med Surg. 2013;32(1):31-34.
  9. Kilmer SL. Prototype CoolCup cryolipolysis applicator with over 40% reduced treatment time demonstrate equivalent safety and efficacy with greater patient preference. Lasers Surg Med. 2016. 
  10. Bolton J, Wu D, Goldman M. Study of a suctionless novel applicator for the treatment of pseudogynecomastia with cryolipolysis. Lasers Surg Med. 2016;48(4):451. 
  11. Derrick CD, Shridharani SM, Broyles JM. The Safety and Ef cacy of Cryo- lipolysis: A Systematic Review of Available Literature. Aesthet Surg J. 2015;35(7):830-836. 
  12. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. 
  13. Jalian HR, Avram MM, Garibyan L, Mihm MC, Anderson RR. Paradoxical adi- pose hyperplasia after cryolipolysis. JAMA Dermatol. 2014;150(3):317-319. 
  14. Macedo O, Chaim CB, Matsumoto L. Case report of a rare side effect associ- ated with cryolipolysis. J Am Acad Dermatol. 2014;70(5):AB195. 
  15. Raphael B, Wasserman D. Paradoxical Adipose Hyperplasia with Cryolipoly- sis: A Case Report. Paper presented at: American Society for Dermatologic Surgery (ASDS) Annual Meeting 2014; San Diego, CA. 
  16. Rai S, Frank P. Paradoxical Adipose Hyperplasia Post-cryolipolysis Occurring in Twins: Is There a Genetic Link? Paper presented at: American Society for Dermatologic Surgery (ASDS) Annual Meeting 2015; Chicago, IL. 
  17. Singh SM, Geddes ER, Boutrous SG, Galiano RD, Friedman PM. Paradoxi- cal adipose hyperplasia secondary to cryolipolysis: An underreported entity? Lasers Surg Med. 2015;47(6):476-478. 
  18. Stefani WA. Adipose Hypertrophy Following Cryolipolysis. Aesthet Surg J. 2015;35(7):Np218-220. 
  19. Kelly E, Rodriguez-Feliz J, Kelly ME. Paradoxical Adipose Hyperplasia after Cryolipolysis: A Report on Incidence and Common Factors Identi ed in 510 Patients. Plast Reconstr Surg. 2016;137(3):639e-640e. 
  20. Seaman SA, Tannan SC, Cao Y, Peirce SM, Gampper TJ. Paradoxical Adipose Hyperplasia and Cellular Effects After Cryolipolysis: A Case Report. Aesthet Surg J. 2016;36(1):Np6-13. 
  21. Sasaki GH. Reply: Cryolipolysis for Fat Reduction and Body Contouring: Safety and Ef cacy of Current Treatment Paradigms. Plast Reconstr Surg. 2016;137(3):640e-641e. 
  22. ZELTIQ Aesthetics Inc. What is CoolSculpting? http://www.coolsculpting. com/what-is-coolsculpting/. Accessed June 17, 2016. 
  23. Jalian HR, Avram M, Anderson RR. Rare side effects associated with cryoli- polysis. Paper presented at: American Society for Laser Medicine and Sur- gery 2013; Boston, MA. 
  24. Keaney TC, Naga LI. Men at risk for paradoxical adipose hyperplasia after cryolipolysis. J Cosmet Dermatol. 2016. 
  25. Fong GH. Regulation of angiogenesis by oxygen sensing mechanisms. J Mol Med (Berl). 2009;87(6):549-560. 
  26. Hausman DB, DiGirolamo M, Bartness TJ, Hausman GJ, Martin RJ. The biol- ogy of white adipocyte proliferation. Obes Rev. 2001;2(4):239-254. 
  27. Youngstrom TG, Bartness TJ. White adipose tissue sympathetic nervous sys- tem denervation increases fat pad mass and fat cell number. Am J Physiol. 1998;275(5 Pt 2):R1488-1493. 
  28. Khouri RK, Rigotti G, Khouri RK, Jr., et al. Tissue-engineered breast recon- struction with Brava-assisted fat grafting: a 7-year, 488-patient, multicenter experience. Plast Reconstr Surg. 2015;135(3):643-658. 
  29. Bangash HK, Eisen DB, Armstrong AW, et al. Who are the Pioneers? A Critical Analysis of Innovation and Expertise in Cutaneous Noninvasive and Minimally Invasive Cosmetic and Surgical Procedures. Dermatol Surg. 2016;42(3):335-351. 

AUTHOR CORRESPONDENCE

Jared Jagdeo MD MS jrjagdeo@gmail.com
Close Menu